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_|Virologist [G. Laver] Endorses Plan to Help Business Stockpile Tamiflu, But Not as Prophylactic|_
Virologist Endorses Plan to Help Business Stockpile Tamiflu, But Not as Prophylactic
by Anthony L. Kimery
Monday, 30 June 2008
But companies need to have 'a designated person on the staff skilled in flu diagnosis'
F. Hoffmann-La Roche, the manufacturer of the antiviral Tamiflu, announced it has launched a program under which US companies can stockpile supplies of the drug in preparation for distribution to employees in the event of a pandemic.
The move comes on the heels of the Department of Health and Human Services (HHS) having told HSToday.us is wrongheaded.
Laver played a key role in the development of both drugs as well as in having found the link between human flu and bird flu.
Laver told HSToday.us that Roche?s program is a good idea, but ?only [if companies who stockpile Tamiflu] hand out [the antiviral] to people who test positive for influenza.?
?Stockpiles by large companies seem to be a very good thing to do.,? Laver said, adding, ?these should be used both in seasonal flu and in a pandemic when one comes along. Such a procedure should be put in place now to deal with next year's flu in the US.?
But Laver said companies should not make the drug available prophylactically. ?It should only be dispensed if employees test positive for influenza ? that is why large companies should have a person or persons specially trained in flu diagnostics.?
Laver earlier told HSToday.us that HHS?s proposed plan to use Tamilfu prophylactically is wrongheaded.
?Prophylaxis with Tamiflu in a pandemic is wrong. Early treatment is the only way to go,? Laver said, as have numerous other authorities, as HSToday.us previously reported.
Laver explained that it is ?much better to use Tamiflu only for early treatment. If people with flu symptoms take Tamiflu immediately, say within six or so hours after symptom onset, the infection should be rapidly terminated, the person should recover, and then, and this is important, should then be immune to reinfection for the rest of the pandemic.?
But ?as soon as prophylaxis is stopped,? Laver said, ?the person taking Tamiflu is just as susceptible to infection as before. Early treatment would be so much better.?
Laver advocates the dispensing of Tamiflu through company programs like Roche is supporting, as well as making Tamiflu ?available over-the-counter [OTC] in pharmacies ? where flu victims can get it without the time-wasting need to first get a prescription from a doctor. There is no need for a prescription and the time taken to get one can render Tamiflu pretty well useless.?
Of course, Laver stated, the pharmaceutical ?community would [need to] be ?trained? in the correct use of these drugs in the event of a pandemic.
It would be ?much better to hold stocks of the drugs in every pharmacy in the country where it can be got quickly after diagnosis by a trained pharmacist or other health care worker.?
Laver said using a rapid flu test to assist such a diagnosis ?so that people who think they have the flu can be properly diagnosed quickly and take the drugs very soon after symptom onset. This rapid procedure of ?test and treat? would mean that the infection should be immediately terminated and the flu victim experience a quick recovery.?
?If companies and other institutions too, like schools, universities, and so on had their own stockpiles of Tamiflu and had a designated person on the staff skilled in flu diagnosis, maybe using a fast flu test, members of staff or students or whatever could be rapidly diagnosed and given or denied Tamiflu depending on the diagnosis. Just imagine how much illness this would prevent??
Laver said ?this procedure should be adopted now, so that the community would become familiar with this ?test and treat? way of dealing with influenza and if a pandemic should suddenly erupt, everyone would [or should] know what to do.?
Addressing the issue of false negatives from a business?s diagnosing its employees, Laver said, ?imagine, if ten people with flu turn up to be tested, seven test positive and get Tamiflu and three test negative, even though they have flu, and are denied Tamiflu. The result is that seven people benefit greatly and the unfortunate three with false negatives will be no worse off than they were previously when there were no fast tests, no Tamiflu and nothing they could do except take chicken soup and go to bed. Meanwhile, seven people would benefit from the treatment. Doesn't that make sense? And these fast flu tests are getting better all the time, so it really does seem to be the way to go.?
While some authorities have raised concerns about the efficacy of Tamiflu, Laver told HSToday.us that ?there is lots of published evidence that Tamiflu and Relenza are effective in both flu treatment and flu prophylaxis if used correctly. Some of the people who deny this make bizarre statements such as ?Tamiflu has no effect on flu-like illness!? Of course not, it is only good for true influenza.?
?Also,? Laver said, ?it is often stated that the duration of illness is only reduced by one to two days. This is nonsense, if the drug is taken very soon after infection, then the reduction in illness may be five or six days or better.
To work, Tamiflu must be taken in proper doses within six to 12 hours after onset of symptoms.
"Forty-eight hours is about the limit the drug is effective," Laver said.
Laver said ?there are also statements that Tamiflu reduces flu symptoms,? but ?cold and flu tablets do that; Tamiflu targets and disables (kills) the virus directly.
Tamiflu works by blocking the action of the neuraminidase (NA) enzyme on the surface of the virus. When neuraminidase is inhibited, the spread of the virus to other cells in the body is inhibited.
?I believe that in most of the human H5N1 bird flu cases that died despite having been given Tamiflu, the drug was given far too late after infection to be effective,? Laver continued. ?It needs to be taken early to stop the virus replicating. It seems that people who die from flu do not die from the virus directly, but as a result of the damage the virus does to the body. This damage results in a ?cytokine storm? released by the body's immune system, and so the earlier the virus is killed the better.?
H5N1 upsets the chemical messengers that regulate immune function in a healthy, vigorous immune system. These chemical messengers activate an inordinate number of immune cells - a ?cytokine storm? - which causes pervasive inflammation and eventual death if not promptly treated with antiviral drugs.
According to a team led by Menno de Jong of the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, ?the focus of clinical management should be on preventing this intense cytokine response by early diagnosis and effective antiviral treatment.?
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Virologist Endorses Plan to Help Business Stockpile Tamiflu, But Not as Prophylactic
by Anthony L. Kimery
Monday, 30 June 2008
But companies need to have 'a designated person on the staff skilled in flu diagnosis'
F. Hoffmann-La Roche, the manufacturer of the antiviral Tamiflu, announced it has launched a program under which US companies can stockpile supplies of the drug in preparation for distribution to employees in the event of a pandemic.
The move comes on the heels of the Department of Health and Human Services (HHS) having told HSToday.us is wrongheaded.
Laver played a key role in the development of both drugs as well as in having found the link between human flu and bird flu.
Laver told HSToday.us that Roche?s program is a good idea, but ?only [if companies who stockpile Tamiflu] hand out [the antiviral] to people who test positive for influenza.?
?Stockpiles by large companies seem to be a very good thing to do.,? Laver said, adding, ?these should be used both in seasonal flu and in a pandemic when one comes along. Such a procedure should be put in place now to deal with next year's flu in the US.?
But Laver said companies should not make the drug available prophylactically. ?It should only be dispensed if employees test positive for influenza ? that is why large companies should have a person or persons specially trained in flu diagnostics.?
Laver earlier told HSToday.us that HHS?s proposed plan to use Tamilfu prophylactically is wrongheaded.
?Prophylaxis with Tamiflu in a pandemic is wrong. Early treatment is the only way to go,? Laver said, as have numerous other authorities, as HSToday.us previously reported.
Laver explained that it is ?much better to use Tamiflu only for early treatment. If people with flu symptoms take Tamiflu immediately, say within six or so hours after symptom onset, the infection should be rapidly terminated, the person should recover, and then, and this is important, should then be immune to reinfection for the rest of the pandemic.?
But ?as soon as prophylaxis is stopped,? Laver said, ?the person taking Tamiflu is just as susceptible to infection as before. Early treatment would be so much better.?
Laver advocates the dispensing of Tamiflu through company programs like Roche is supporting, as well as making Tamiflu ?available over-the-counter [OTC] in pharmacies ? where flu victims can get it without the time-wasting need to first get a prescription from a doctor. There is no need for a prescription and the time taken to get one can render Tamiflu pretty well useless.?
Of course, Laver stated, the pharmaceutical ?community would [need to] be ?trained? in the correct use of these drugs in the event of a pandemic.
It would be ?much better to hold stocks of the drugs in every pharmacy in the country where it can be got quickly after diagnosis by a trained pharmacist or other health care worker.?
Laver said using a rapid flu test to assist such a diagnosis ?so that people who think they have the flu can be properly diagnosed quickly and take the drugs very soon after symptom onset. This rapid procedure of ?test and treat? would mean that the infection should be immediately terminated and the flu victim experience a quick recovery.?
?If companies and other institutions too, like schools, universities, and so on had their own stockpiles of Tamiflu and had a designated person on the staff skilled in flu diagnosis, maybe using a fast flu test, members of staff or students or whatever could be rapidly diagnosed and given or denied Tamiflu depending on the diagnosis. Just imagine how much illness this would prevent??
Laver said ?this procedure should be adopted now, so that the community would become familiar with this ?test and treat? way of dealing with influenza and if a pandemic should suddenly erupt, everyone would [or should] know what to do.?
Addressing the issue of false negatives from a business?s diagnosing its employees, Laver said, ?imagine, if ten people with flu turn up to be tested, seven test positive and get Tamiflu and three test negative, even though they have flu, and are denied Tamiflu. The result is that seven people benefit greatly and the unfortunate three with false negatives will be no worse off than they were previously when there were no fast tests, no Tamiflu and nothing they could do except take chicken soup and go to bed. Meanwhile, seven people would benefit from the treatment. Doesn't that make sense? And these fast flu tests are getting better all the time, so it really does seem to be the way to go.?
While some authorities have raised concerns about the efficacy of Tamiflu, Laver told HSToday.us that ?there is lots of published evidence that Tamiflu and Relenza are effective in both flu treatment and flu prophylaxis if used correctly. Some of the people who deny this make bizarre statements such as ?Tamiflu has no effect on flu-like illness!? Of course not, it is only good for true influenza.?
?Also,? Laver said, ?it is often stated that the duration of illness is only reduced by one to two days. This is nonsense, if the drug is taken very soon after infection, then the reduction in illness may be five or six days or better.
To work, Tamiflu must be taken in proper doses within six to 12 hours after onset of symptoms.
"Forty-eight hours is about the limit the drug is effective," Laver said.
Laver said ?there are also statements that Tamiflu reduces flu symptoms,? but ?cold and flu tablets do that; Tamiflu targets and disables (kills) the virus directly.
Tamiflu works by blocking the action of the neuraminidase (NA) enzyme on the surface of the virus. When neuraminidase is inhibited, the spread of the virus to other cells in the body is inhibited.
?I believe that in most of the human H5N1 bird flu cases that died despite having been given Tamiflu, the drug was given far too late after infection to be effective,? Laver continued. ?It needs to be taken early to stop the virus replicating. It seems that people who die from flu do not die from the virus directly, but as a result of the damage the virus does to the body. This damage results in a ?cytokine storm? released by the body's immune system, and so the earlier the virus is killed the better.?
H5N1 upsets the chemical messengers that regulate immune function in a healthy, vigorous immune system. These chemical messengers activate an inordinate number of immune cells - a ?cytokine storm? - which causes pervasive inflammation and eventual death if not promptly treated with antiviral drugs.
According to a team led by Menno de Jong of the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, ?the focus of clinical management should be on preventing this intense cytokine response by early diagnosis and effective antiviral treatment.?
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